腹腔镜手术与开腹手术治疗直肠脱垂临床效果比较的Meta分析

Comparison of the clinical effects between laparoscopy and open surgery on rectal prolapse: a Meta-analysis

目的系统评价腹腔镜手术(LS)与开腹手术(OS)治疗直肠脱垂的有效性及安全性。方法检索2000年1月1日至2014年5月1日公开发表在PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CMB)、维普(VIP)及万方文献数据库的LS与OS治疗直肠脱垂疗效比较的研究文献,并用RevMan 5.2软件进行Meta分析。结果共有11篇文献900例直肠脱垂患者被纳入分析,其中LS组482例,OS组418例。与OS相比,LS手术时间延长(WMD=53.42,95%CI:45.34~61.49,Z=12.97,P<0.05)、患者住院时间缩短(WMD=-2.42,95%CI:-3.07^-1.78,Z=7.37,P<0.05)、便秘发生率明显改善(OR=0.55,95%CI:0.30~0.99,Z=2.01,P<0.05),而在围手术期并发症发生率、术后复发率及死亡率方面,两种术式的差异无统计学意义(OR=1.05,95%CI:0.55~1.98,Z=0.14,P>0.05;OR=0.86,95%CI:0.51~1.45,Z=0.56,P>0.05;OR=0.48,95%CI:0.20~1.14,Z=1.66,P>0.05)。结论 LS治疗直肠脱垂的短期和长期疗效均优于OS。

Objective To evaluate the safety and feasibility of laparoscopic surgery（LS） vs. open surgery（OS） for rectal prolapse. Methods Literature search was performed using PubMed, Embase, Cochrane Library, CNKI, CMB, VIP and Wan fang database from January 1, 2000 to May 1, 2014 for comparative studies assessing LS vs. OS for rectal prolapse. Meta-analyses were conducted using RevMan 5.2 software. Results 11 studies of 900 cases of rectal prolapse patients were included in this study. There were 482 patients in LS group and 418 patients in the OS group. In the LS group the operation time was statistically longer than in the OS group[weighted mean difference （WMD）=53.42, 95% CI： 45.34-61.49, Z=12.97, P〈0.05] and shorter postoperative hospitalization （WMD=-2.42, 95% CI： -3.07--1.78, Z=7.37, P〈0.05） and the incidence of postoperative defecation incontinence improved significantly （OR=0.55, 95%CI： 0.30-0.99, Z=2.01, P=0.04）. There was no statistical difference relating preoperative complications, postoperative recurrence rate or mortality between the two groups （OR=1.05, 95%CI：0.55-1.98, Z=0.14, P〉0.05;OR=0.86, 95% CI： 0.51-1.45, Z=0.56, P〉0.05; OR=0.48, 95% CI： 0.20-1.14, Z=1.66, P〉0.05）. Conclusion Compared to OS, short-term and long-term clinical outcomes after LS are favorable.